Some Catholic physicians, including those who do not prescribe contraceptives, are questioning the safety of allowing oral contraceptives to be sold over the counter, as the nation's largest body of obstetricians and gynecologists recommended in December.
Dr. Kathleen Raviele, an obstetrician-gynecologist in Atlanta and former president of the Catholic Medical Association, warned that because birth-control pills can raise blood pressure and cause strokes and heart attacks, such drugs should only be prescribed by a physician.
"A woman (being) on a strong medication like that without a physician's supervision could be very dangerous," she said.
Raviele raised the concerns after the American Congress of Obstetricians and Gynecologists, through a committee opinion, recommended that birth-control pills be made available over the counter, much like allergy medicines and cough syrup.
The Washington-based physicians' congress said that unintended pregnancy remains a major public health problem in the United States, accounting for half of all pregnancies. The solution, it said, is wider access to hormonal contraceptives.
It did not mention that not all unintended pregnancies are unwanted or discuss the number of unwanted conceptions that occur despite the use of artificial birth control.
The organization's committee stated that the risks associated with birth-control pills pose no greater risk than acetaminophen, the generic term for Tylenol.
The American Congress of Obstetricians and Gynecologists did not return calls seeking comment about criticisms of the over-the-counter proposal.
Dr. Ryan Welter, a family physician in Taunton, Mass., pointed out that acetaminophen itself poses risks when overused. Hormonal contraceptives, on the other hand, pose significant health risks at their normal dose, he explained, calling the sale of such contraceptives over-the-counter a "bad medical decision."
More than 90 percent of American obstetricians and gynecologists are certified through the physicians' congress, but the committee opinion represents a small portion of its members. Moreover, a November survey suggested committee members were in the minority.
Of the 638 obstetricians, gynecologists and family practitioners interviewed in "Physician Attitudes Toward Over the Counter Availability for Oral Contraceptives," a large majority -- 71 percent -- said they were against over-the-counter hormonal contraceptives. More than 90 percent of respondents cited safety as their primary concern.
In the past, the American Congress of Obstetricians and Gynecologists has promoted other positions at odds with Catholic physicians. In 2007, the organization said obstetricians and gynecologists had an "ethical duty" to refer for abortions and perform them in situations where no other physician is readily available.
The congress also pushed for the approval of the morning-after pill, known as Plan B, to be sold over-the-counter. Plan B, known generically as levonorgestrel, uses large doses of birth-control pills to prevent conception up to 72 hours after unprotected sex.
In 2006, the Food and Drug Administration approved over-the-counter sales of Plan B to women 18 and older; three years later a court ruling made it available to women 17 and older without a prescription. Anyone younger still needs a prescription.
Advocates said making Plan B more widely available would decrease unplanned pregnancies and abortion, but studies have found that does not decrease the number of abortions and could be linked to an increase in sexually transmitted diseases.
One of the most recent studies, "The Impact of Emergency Birth Control on Teen Pregnancy and STIs" by a Nottingham University professor in Great Britain and released in January 2011, found no change in pregnancy rates but discovered a 12 percent increase in the sexually transmitted disease rate among teenagers who had access to free Plan B at pharmacies.
According to the Catechism of the Catholic Church, the use of contraceptives is intrinsically evil. The church teaches that the only acceptable means to space births is through natural family planning, which involves interpreting a woman's bodily signs to determine fertility.
Joanne Bangs, who speaks to young couples about natural family planning in the Diocese of Fall River, Mass., called that method of spacing births the "best-kept secret for a good marriage." That method of birth control treats intimacy as a sacred act and strengthens marriage by placing "everything in right order," she said.
Dr. Lester Ruppersberger, a Catholic obstetrician-gynecologist in Lansdowne, Pa., said the pill does not treat or cure any disease. "It is one of the few pharmaceuticals that is for nothing other than lifestyle and personal choices," he said.
Being a natural family planning-only physician is difficult, Ruppersberger said, because many women expect their doctor to prescribe contraceptives. Even though he is morally opposed to the distribution of birth-control pills, Ruppersberger said approving them for over-the-counter sale could come with some benefits.
"It would take the onus of prescribing hormonal contraception, which is the most-used contraceptive, and put it into the hands of individual women and pharmacists," he said. "Catholic OBGYNs would not need to materially cooperate with evil."
Over-the-counter sales of contraceptives would not likely take place for at least a couple of years, if at all. A pharmaceutical company would have to first seek FDA approval for the move.
[Christine M. Williams is a correspondent for The Anchor, newspaper of the Diocese of Fall River, Mass.]